<html>
<body bgcolor="cyan">
<form action="./PatientInsert" method="post">
<table border="2" align="center">
<tr>
<th>
PName
</th>
<td>
<input type="text" name="pname">
</td>
</tr>
<tr>
<th>
PAddress
</th>
<td>
<input type="text" name="paddr">
</td>
</tr>
<tr>
<th>
Diesease
</th>
<td>
<input type="text" name="diesease">
</td>
</tr>
<tr>
<td>
Drugs
</td>
<td>
<input type="checkbox" name="drugs" value="Insulin">
Insulin
<br>
<input type="checkbox" name="drugs" value="cyllergy">
cyllergy
<br>
<input type="checkbox" name="drugs" value="penculin">
penculin
<br>
</td>
</tr>
<tr>
<td>
<input type="submit" value="register">
</td>
</tr>
</table>
</form>
</body>
</html>